Medications for Social Anxiety Disorder

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

All of the medications used to treat
social anxiety disorder
require a prescription from your doctor. There are many options, some of which are listed below. Some of the medications are more appropriate for people who have the performance type of social anxiety disorder. These medications may be given just before an anxiety-provoking event. Other medications may be taken on a regular basis to treat the symptoms of a more generalized social anxiety disorder.

Medications are usually combined with some form of counseling.

Selective Serotonin Reuptake Inhibitors
(SSRIs)

Common names include:

Citalopram

Escitalopram

Paroxetine

Fluoxetine

Sertraline

SSRIs effect the concentration of the neurotransmitter serotonin. Serotonin plays a role in
anxiety. Although they are considered antidepressants, SSRIs have been used effectively to treat anxiety disorders. They are considered the drugs of choice for this condition. Improvement is usually seen 4-6 weeks after beginning treatment. SSRIs are not addictive. Do not take an SSRI if you have taken a monoamine oxidase inhibitor (MAOI) in recent weeks.

These drugs should be used with caution in the elderly and those with liver or kidney diseases. During therapy, your doctor will be monitoring your heart rate, blood pressure, liver and kidney functions, and worsening depression, including increased suicide risk.

Risk of severe mood and behavior changes, including suicidal thoughts in some (young adults may be at a higher risk for this side effect.)

Benzodiazepines

Common names include:

Lorazepam

Clonazepam

Oxazepam

Diazepam

Alprazolam

Benzodiazepines reduce symptoms of anxiety by enhancing the function of gamma aminobutyric acid (GABA). GABA is a neurotransmitter thought to be abnormal in people with social anxiety disorder. These drugs produce a sedative effect, reduce physical symptoms (such as muscle tension), and often cause drowsiness and lethargy. The advantage of benzodiazepines is that they are fast acting and useful for treating acute anxiety and
insomnia.
Benzodiazepines are usually used 30-60 minutes before an anxiety-provoking event in people with the performance type of social anxiety disorder.

These drugs can be habit-forming. They may be used in short term situations and in combination with an antidepressant. When discontinued, they may cause withdrawal symptoms such as anxiety, irritability, and insomnia. Withdrawal can be life threatening in some cases. Stopping this medication should be done slowly, over a period of weeks or months, and under a doctor’s supervision. The long term use of benzodiazepines for social anxiety disorder is not recommended.

Do not take these drugs with alcohol or other sedating drugs. Do not take if you must drive a vehicle or operate equipment. Use with caution in the elderly, those with liver, lung, kidney diseases,
myasthenia gravis
,
sleep apnea,
drug abuse
or
alcohol use disorder,
seizure disorder, or
porphyria. These drugs should not be taken in combination with certain oral antifungal medications and in people with certain types of
glaucoma.

Beta-blockers have been used effectively to reduce symptoms of social anxiety. They reduce the production of hormone called adrenaline. They also affect the response of certain nerve impulses in the body.
Beta-blockers are usually used 30-60 minutes before an anxiety-provoking event in people with the performance type of social anxiety disorder.

Beta-blockers are contraindicated with
asthma
and certain heart problems. They should be used cautiously with many medical disorders. Withdrawal should be done slowly, under a doctor’s supervision.

Possible side effects include:

Fatigue, weakness

Lightheadedness

Drowsiness

Nausea or vomiting

Slow heart rate

Trouble breathing

Depression

Decreased sexual arousal

Difficulty sleeping

Tricyclic Antidepressants

Common names include:

Doxepin

Clomipramine

Nortriptyline

Amitriptyline

Imipramine

Maprotiline

Nortriptyline

Desipramine

Trimipramine

Protriptyline

In rare cases of severe social anxiety disorder, when there is no good response to an SSRI, your doctor may consider using a tricylic antidepressant.
Tricyclic antidepressants regulate serotonin and/or noradrenalin in the brain. They have been used effectively to treat social anxiety disorder. However, they are not used as often because they are associated with more adverse effects than SSRIs and do not have any added benefits. Improvement is usually seen 2-6 weeks after beginning treatment. Tricyclic antidepressants are not addictive. These drugs should be used with caution in the elderly and those with liver or kidney disease. Do not take this medication if you have glaucoma, are recovering from a
heart attack, or are also taking MAOIs. During therapy, your doctor will be monitoring your heart rate, blood pressure, body weight, liver function, and blood count.

Risk of severe mood and behavior changes, including suicidal thoughts in some (young adults may be at a higher risk for this side effect.)

Atypical Antidepressants

Common names include:

Trazodone

Venlafaxine

Atypical antidepressants affect the concentration of the neurotransmitter serotonin. They can be effective in treating social anxiety. Improvement is usually seen 4-6 weeks after beginning treatment.

Possible side effects include:

Nausea

Nervousness

Reduced sex drive

Risk of severe mood and behavior changes, including suicidal thoughts in some (young adults may be at a higher risk for this side effect.)

Monoamine Oxidase Inhibitors (MAOIs)

Common names include:

Isocarboxazid

Phenelzine

Tranylcypromine

In rare cases of severe social anxiety disorder, when there is no good response to an SSRI or a tricyclic antidepressant, your doctor may consider using monoamine oxidase inhibitors (MAOIs). MAOIs are a type of antidepressant that reduces symptoms of social anxiety disorder. They prevent the breakdown of dopamine, epinephrine, norepinephrine, serotonin, and noradrenalin. Improvement is usually seen 2-6 weeks after beginning treatment. MAOIs are not addictive. These antidepressants are used to treat generalized social anxiety disorder. They are considered a last choice.

There is a risk of serious reactions when taking MAOIs. There are many medications, both prescribed and over-the-counter, that you will need to avoid. Examples of medications to avoid include:

Ask your doctor for a complete list of medications to avoid. Also, talk to your doctor before taking any new medication, including over-the-counter medications and herbs and supplements.

When taking MAOIs, there is the risk of a life-threatening side effect, called serotonin syndrome. This occurs when MAOIs interact with other antidepressant medications, such as serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). In serotonin syndrome, levels of serotonin in the brain get dangerously high. This can cause confusion, hallucinations,
seizures, and other symptoms. This is an emergency. To avoid interactions, it is generally recommended to wait 2-5 weeks before stopping MAOIs and starting another antidepressant. Ask your doctor about the specific medication you are taking.

Because of the risk of serious reactions, there are also dietary restrictions when taking MAOIs. Avoid eating foods with high tyramine content. Tyramine is an amino acid that helps regulate blood pressure. If you have too much tyramine and are taking MAOIs, your blood pressure may become dangerously high. This is called hypertensive crisis. In some cases, this can lead to a
stroke. Examples of foods with high tyramine content include:

Cheese

Alcohol

Organ meats

Nuts

Peanut butter

Fava beans

Onions

Avocados

Canned figs

Chocolate

Excessive amounts of caffeine

Foods containing monosodium glutamate (MSG)

Foods that are pickled, marinated, smoked, cured, or fermented

Ask your doctor for a complete list of foods and drinks to avoid.

During therapy, your doctor will monitor your heart rate, blood pressure, liver and kidney functions, and worsening depression, including increased suicide risk. MAOIs should be used with caution in the elderly and those with liver and kidney diseases.

MAOIs can cause birth defects. They should not be taken by pregnant women. Also, the medication should not be taken if you have certain conditions, such as stroke,
coronary artery disease, or pheochromocytoma (tumor in the adrenal gland).

There are many side effects, some severe, that can be caused by MAOIs. Because of this, doctors will usually try other medications before prescribing MAOIs. Some side effects include:

Risk of severe mood and behavior changes, including suicidal thoughts in some (young adults may be at a higher risk for this side effect.)

Special Considerations

Consultation with a specially trained provider is recommended if you do not respond to treatment with medications. The provider can help clarify the diagnosis and determine if another psychiatric disorder is present. The provider can also make recommendations about psychotherapy and changes in medications. Psychiatrists, psychologists, social workers, or specially trained doctors can treat social anxiety disorder. Ask your doctor if she has helped other people with social anxiety disorder. If your doctor does not have special training, ask for the name of a doctor or counselor who does.

If you are taking medications, follow these general guidelines:

Take the medication as directed. Do not change the amount or the schedule.

Ask what side effects could occur. Report them to your doctor.

Talk to your doctor before you stop taking any prescription medication.

Do not share your prescription medication.

Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.

Social phobia. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/psychiatric-disorders/anxiety-and-stressor-related-disorders/social-phobia. Updated May 2014. Accessed June 27, 2017.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.